Willing and Unable

Doctors’ Constraints in Abortion Care

Lori Freedman

Publication Year: 2010

Willing and Unable explores the social world where abortion politics and mainstream medicine collide. The author interviewed physicians of obstetrics and gynecology around the United States to find out why physicians rarely integrate abortion into their medical practice. While abortion stigma, violence, and political contention provide some explanation, her findings demonstrate that willing physicians are further encumbered by a variety of barriers within their practice environments.
Structural barriers to the mainstream practice of abortion effectively institutionalize the buck-passing of abortion patients to abortion clinics. As the author notes, "Public-health-minded HMOs and physician practices could significantly change the world of abortion care if they stopped outsourcing it."
Drawing from forty in-depth interviews, the book presents a challenge to a commonly held assumption that physicians decide whether or not to provide abortion based on personal ideology. Physician narratives demonstrate how their choices around learning, doing, and even having abortions themselves disrupt the pro-choice/pro-life moral and political binary.

Cover

Title Page/Copyright

Contents

Preface

Today, in the early twenty-first century in the United States, health policymakers,
ethicists, and advocates are actively debating the rights of health
practitioners to deliver care according to their own consciences. The idea
that particularly troubles Americans is that physicians could be forced to
participate in abortion care (or other reproductive health care) when they...

Acknowledgments

I can start nowhere else but with a heartfelt thank-you to my mentor Carole
Joffe. Her support over the past decade has been steadfast and essential.
Carole is an inspirational model for engaged academia, never losing sight
of the bigger picture and its constituents. I am grateful to Drew Halfmann
for his incisive feedback and masterful way of helping me understand...

Chapter 1: Introduction

That was probably the most disappointing thing about training residents. You know, for what? To do nothing? I mean, they obviously would refer [their abortion] patients, and they would take good care of their patients, both pre- and post-care. But, you know, it was disappointing to not have them have the guts to stand up and say, “I’m going to do it.”...

Chapter 2: Abortion in American Medicine: A Recent History

In 1995, Dr. Jane Hodgson, abortion provider and heroine in the movement
to legalize abortion, wrote an editorial in the British Medical Journal reflecting
on the period of legalized abortion in the United States. In it she
lamented the problems that plagued abortion care—problems that, unlike
antiabortion activism, were fostered within American medicine itself:...

Chapter 3: Unwilling, Willing, and Why

A recent national survey showed that only 22 percent of ob-gyns in the
United States had performed an abortion in the previous year (Steinauer
et al. 2008).1 The same survey also found that, of all ob-gyns who had
intended (preresidency) to provide abortions after completion of their
training, only half (52 percent) did so. Of those who had not intended to...

Dr. Rina Anderson and I played phone tag for months before our interview.
I planned to interview her by phone because I was unable to travel to
her city. When she first returned my call, she left a message saying, “I’m
thirty-six weeks pregnant, on bed rest. It’s a great time for me to talk.”
But when I returned her call a week later, she had already had the baby...

For decades, abortion rights activists and scholars have argued that abortion
should be integrated into mainstream medical care and hence treated as
a legitimate part of full-spectrum reproductive health services (Lindheim
1979; Rose 2007). In theory, getting abortion services out of the clinics
and into doctors’ offices would reduce stigma and make abortion care...

Dr. Brian Smits decided to pursue a fellowship in perinatology when he
graduated residency in the late 1990s because male ob-gyns were “just
not finding jobs.” Female patients had become increasingly interested in
having female physicians. But that was not the only reason he decided
to subspecialize. “I really enjoyed high-risk obstetrics,” he explained...

Chapter 7: Conclusion

At the beginning of this book I asked, What happened to Dr. Chasey’s residents
after he trained them in abortion care? Dr. Chasey had spent most
of his career as the director of a midwestern residency’s hospital-based
abortion service. He wished, aloud, that his residents had the courage (or
“guts,” as he put it) to face the challenges of providing abortion and that...

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